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目的:探讨小儿永久心内膜起搏导线的可靠性。方法:对8例先天性心脏病完全性房室传导阻滞患儿行永久心脏起搏治疗,采用常规的经锁骨下穿刺心内膜起搏方法,起搏模式除1例为单导线VDDR起搏外,其余均为VVI起搏。心内膜导线置入时在心腔内形成1个圆圈以应对患儿身体增长,早期2例仅为半圈。结果:1例于术后3个月猝死(原因不详);其余7例存活且追踪时间0.5～15.8年(平均5.5年)。追踪检查时,患儿身高、体重均已明显增长;起搏器功能稳定,起搏阈值及R波幅度均在正常变化范围之内;经胸超声检查心腔内沿起搏导线周围未见血栓形成,患儿无血栓形成的临床表现;胸部X线可见心腔内导线形状有一定变化,但圆圈仍存;1例VDDR出现间歇性心房感知不良,可能与导线形状改变有关,但起搏功能良好。结论:小儿永久起搏可采用常规的心内膜起搏方法,为应对小儿身体的增长使导线在心腔内保持1个圆圈,可以获得长期的稳定起搏。
Objective: To investigate the reliability of pediatric permanent endocardial pacing lead. Methods: Eight children with congenital heart disease with complete atrioventricular block were treated with permanent cardiac pacing. The conventional subcapsular endocardial pacing method was used. In addition to one case of pacing mode VDVD Stroke, the rest are VVI pacing. Endocardial guide wire into the formation of a circle within the heart chamber in response to the growth of children with early 2 cases only half a circle. RESULTS: One patient died suddenly 3 months after surgery (unexplained); the remaining 7 patients survived and had a follow-up of 0.5-15.8 years (mean 5.5 years). During follow-up examination, the height and weight of the children increased obviously. The function of the pacemaker was stable, the threshold of thoracic pace and the amplitude of R wave were within the range of normal variation. The transthoracic echocardiography showed no thrombus around the pacing lead Formed, the clinical manifestations of children without thrombosis; chest X-ray shows intracardiac lead shape has some changes, but the circle still exists; 1 case of VDDR intermittent atrial hypothyroidism may be related to changes in lead shape, but pacing function good. Conclusion: Perpetual pacing in children may use the conventional endocardial pacing method. In order to cope with the growth of children, the wire should maintain a circle in the heart cavity to obtain long-term stable pacing.